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Our Elder Care “System” is Already Broken, and It’s Going to Get Much Worse

An excellent report by The New York Times and KFF Health News, “Dying Broke: Facing Financial Ruin as Costs Soar for Elder Care,” describes the financial and personal toll on families providing care to ailing elders in our fractured “system.” Very few families can afford to pay out of pocket for home health, assisted living, or nursing home care for any length of time. Those who cannot must provide care themselves, often giving up outside employment or time with their own families, or both. Or older couples prop one another up for as long as they can. It’s not unusual for us to see couples where one spouse is facing cognitive decline and the other physical restrictions. Together, they can take care of themselves, until at some point they can’t any longer.

For financial support, families must rely on Medicaid (MassHealth), navigating the “program’s byzantine rules.” Those complex and shifting rules have in large part given rise to the field of elder law as families have sought guidance on their journeys through the system.

The Demographic Reality

What the article misses is the fact that the current situation is going get much worse. This is because of two realities: First, most people don’t need assistance until they get into their late 80s. Second, the number of such older seniors alive today is relatively small because few babies were being born 85 years ago in the midst of the Great Depression.

According to one study, only 3.4% of Americans between ages 65 and 74 need assistance with activities of daily living. This doubles to 7.0% percent for those between 75 and 84, and then triples to 20.7% for seniors aged 85 and older.

We’re actually in a demographic trough right now in terms of the number of older seniors in the United States. Close to three million babies a year were being born in the United States during the 1910s and 1920s. This dropped to fewer than 2.4 million babies in 1935, and then the baby floodgates opened after World War II producing the proverbial Baby Boom. The country produced more than four million babies a year from 1954 through 1964, reaching a peak of 4.3 million in 1957. (After 1964, we did not again breach the four million baby threshold until 1989 and have hovered around that number ever since, never reaching the 1957 number, even though there are almost twice as many people living in the United States today, 334 million, as compared with the 167 million in 1957.)


The oldest Baby Boomers will breach the age-85 threshold in 2031. Those born in the peak year of 1957 will turn 85 in 2042. It’s estimated that the number of Americans age 85 and over will more than double from 6.6 million today to 14.4 million in 2040 and 19 million in 2050.

Will We Prepare?

If we can’t take care of today’s seniors today without great strain on their families, we’re certainly not prepared care for triple today’s older old population in less than three decades. Any hope that the care need will be significantly reduced by a cure for Alzheimer’s disease, robots that replace human caregivers, or other medical or technological advances is engaging in magical thinking (akin to the idea that carbon sequestration will be the solution to global warming). That doesn’t mean we shouldn’t continue research in these areas, just that we can’t rely on such research as a solution to the elder care crisis coming our way.

Fortunately, we have about a decade to get ready for the looming onslaught of care needs. The question is whether as a society we have the will to address this foreseeable crisis before it arrives.

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